老年骨外伤患者感染病原菌分布与对血清核因子κB受体活化因子配体和瘦素水平的影响研究

Distribution of pathogens causing infections in elderly patients with bone trauma and impact on levels of serum receptor activator of nuclear factor-κB ligand and leptin

目的分析老年骨外伤患者术后感染病原菌的分布,并探讨其对患者血清中核因子κB受体活化因子配体(RANKL)及瘦素水平的影响,为临床治疗提供借鉴。方法选取2010年6月-2013年12月医院诊治的96例老年骨外伤术后感染患者,设为感染组,选取医院同期老年骨外伤术后未感染患者160例设为未感染组,同期健康体检者160名为对照组;采用BD公司全自动微生物鉴定仪分析病原菌类型,酶联免疫吸附测定法分析患者感染后血清中核因子κB的受体激活剂配体(RANKL)及瘦素水平变化;使用SPSS20.0软件进行统计分析。结果 96例老年骨外伤术后感染患者共分离病原菌96株,其中革兰阳性菌47株占49.0%,以酿脓链球菌和金黄色葡萄球菌为主,革兰阴性菌49株占51.0%,以肺炎克雷伯菌和淋病奈瑟菌为主;老年骨外伤患者感染病原菌后血清中RANKL、核因子κB受体活化因子(RANK)和护骨素(OPG)及TNFα水平明显高于对照组和未感染组;感染患者血清中瘦素、瘦素受体及骨钙蛋白水平明显升高而过氧化物酶体增殖物激活受体(PPARγ)水平明显降低,且与对照组和未感染组比较差异有统计学意义(P<0.01)。结论老年骨外伤患者容易感染病原菌,且感染能够明显干预血清护骨素-核因子κB受体活化因子-核因子κB受体活化因子配体(OPG-RANK/RANKL)及瘦素系统异常。

OBJECTIVE To investigate the distribution of pathogens causing postoperative infections in elderly patients with bone trauma and observe the impact on the levels of serum receptor activator of nuclear factor-κB ligand（RANKL）and leptin so as to provide guidance for clinical treatment.METHODS A total of 96 elderly bone trauma patients with postoperative infections who were treated in the hospital from Jun 2010 to Dec 2013 were enrolled in the study and assigned as the infection group,meanwhile,160 elderly bone trauma patients without postoperative infections were set as the control group,and 160 healthy people who received physical examination were chosen as the control group.The pathogens were identified by using the automatic microorganism identification system of BD company,the levels of RANKL and leptin of the patients with infections were determined by means of enzymelinked immunosorbent assay,and the statistical analysis was performed with the use of SPSS20.0software.RESULTS Totally 96 strains of pathogens were isolated from the 96 elderly bone trauma patients with postoperative infections,including 47（49.0%）strains of gram-positive bacteria and 49（51.0%）strains of gram-negative bacteria;Streptococcus pyogenes and Staphylococcus aureus were the predominant species of the gram-positive bacteria;Klebsiella pneumoniae and Neisseria gonorrhoeae were dominant among the gram-negative bacteria.The levels of serum RANKL,receptor activator of nuclear factor-Κb（RANK）,osteoprotegerin（OPG）,and TNFαwere significantly higher in the infection group than in the control group and the non-infection group.The levels of serum leptin,leptin receptor,and osteocalcin of the patients with the infections were remarkably elevated,while the level of peroxisome proliferator-activated receptor（PPARγ）was significantly reduced,as compared with the control group and the non-infection group（P〈0.01）.CONCLUSIONThe elderly bone trauma patients are at high risk of infections.The serum OPG-RANKG-RANK and leptin system are significantly affected by the infections.